Laserfiche WebLink
t � ' <br /> .�.:�� <br /> ��,,_: <br /> .���.� N� <br /> � _ � �r � � ��� <br /> :� <�� f_.. (���� 0 <br /> �.�� _ .�.� w � <br /> x�:�; ., �'�' � <br /> R-�'a� Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices <br /> _ '=yk`;w " <br /> � <br /> � _ � � On the North Shore of Lake Minnetonka <br /> DATA PRNACY ADVISORY <br /> In accordance with M.S. 13.04 , Subd. 2, "Rights of sub erm t or <br /> data", we would Iike to inform you that your request for a P Ze uire <br /> Iicense f rom the City of Orono or any of its departments may q <br /> you to furnish certain private or confidential. information. <br /> You are notified that: <br /> l. The information you furnish wil3 be used to determine your <br /> qualification for the permit or Iicense requested. <br /> 2. You may refuse to supply data, but refusal may require that <br /> the City deny the permit or Iicense. <br /> 3. The information may be shared with ot�o esscthe permit or <br /> federal agencies to the extent necessary to p <br /> I.icense. <br /> 4. If your requested permit or Iicense requires Councii ac��or. <br /> to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review priva�e <br /> data on yourself. <br /> 6. Your full name is required to process this application or <br /> permit. <br /> ,,L/s�i t1�D /"'Lf34iLi ///�-4- G G s���'� <br /> First <br /> Middle Last <br /> '`7 G� .�/Z G:G-L -�G �� �' <br /> Address <br /> U/ZG%�i' > N�� �- �c- `� <br /> City State Zip <br /> `f7i -pSzO <br /> Phone <br /> I understand my rights as stated above. <br /> ,� ��/,G �'�-f'-� � <br /> Signature � <br /> BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 <br /> • PUBLIC WORKS—473-7359 <br /> ASSESSING <br />